Department of Orthopedics, The Third People's Hospital of Shenzhen, Shenzhen, Guangdong Province, China.
Department of Hematology, The Second People's Hospital of Shenzhen, Shenzhen, Guangdong Province, China.
Orthop Surg. 2022 Oct;14(10):2741-2749. doi: 10.1111/os.13457. Epub 2022 Aug 26.
To report the modified osteotomy and the short-term effectiveness of the total elbow joint replacement in patients of hemophilic elbow arthritis with severe flexion contracture deformity.
This study introduced the therapeutic approach of the total elbow joint replacement in patients of hemophilic elbow arthritis with severe flexion contracture deformity, and assessed the short-term effectiveness in three cases (three elbows) of end-stage hemophilic elbow arthritis admitted from October 2020 to December 2020. The included patients were all diagnosed with hemophilia A (factor VII deficiency), accompanied by severe bilateral elbow joint flexion contracture, which seriously affects daily life and requires surgical intervention. Clinical data and follow-up results were analyzed before total elbow arthroplasty and 1, 3, and 6 months postoperatively. Pre- and postoperative range of motion, pain score, and function score were compared, and intraoperative and postoperative complications are reported.
All three patients were male, with an average age of 31 years. The main clinical manifestations were bilateral elbow arthritis with flexion contracture. Two of the patients underwent right elbow replacement, and one patient underwent left elbow replacement. All cases were followed up for 6 months postoperatively. No incision infection or ulnar nerve injury occurred. Postoperative triceps brachii muscle strength was slightly weakened compared with preoperative muscle strength. Average elbow flexion and extension range of motion was 60° (30°-100°) preoperatively and increased to 127° (110°-140°) postoperatively; rotational range of motion of the affected forearm was 47° (10°-85°) preoperatively and increased to 117° postoperatively. The mean visual analogue scale (VAS) was 6 (5-8) preoperatively and decreased to 3 (2-4) postoperatively. The mean MEPS score was 62 (55-75) and increased to 87 (80-95) postoperatively. During the follow-up, anteroposterior and lateral radiographs showed no signs of prosthesis loosening in the elbow.
For severe hemophilic elbow arthritis patients, the short-term treatment effect of total elbow replacement is good, following the strict adherence to the surgical indications and proper preparation for the perioperative period. The modified osteotomy can fully expose the visual field and reduce complications of ulnar nerve injury. The long-term effects need to be study future.
报告血友病性肘关节炎伴严重屈曲挛缩畸形患者改良截骨术和全肘关节置换术的短期疗效。
本研究介绍了血友病性肘关节炎伴严重屈曲挛缩畸形患者的全肘关节置换治疗方法，并评估了 2020 年 10 月至 12 月收治的 3 例（3 个肘关节）终末期血友病性肘关节炎患者的短期疗效。纳入的患者均诊断为血友病 A（因子 VII 缺乏症），伴有严重双侧肘关屈曲挛缩，严重影响日常生活，需要手术干预。分析全肘关节置换术前及术后 1、3、6 个月的临床资料和随访结果。比较术前和术后关节活动度、疼痛评分和功能评分，并报告术中及术后并发症。
3 例患者均为男性，平均年龄 31 岁。主要临床表现为双侧肘关节炎伴屈曲挛缩。其中 2 例患者行右侧肘置换术，1 例患者行左侧肘置换术。所有患者均获得术后 6 个月随访。无切口感染或尺神经损伤发生。术后肱三头肌肌力较术前轻度减弱。平均肘屈伸活动度由术前的 60°（30°-100°）增加至术后的 127°（110°-140°）；患侧前臂旋转活动度由术前的 47°（10°-85°）增加至术后的 117°。术前视觉模拟评分（VAS）平均为 6（5-8）分，术后降至 3（2-4）分。术前改良 Mayo 肘关节功能评分（MEPS）平均为 62（55-75）分，术后增至 87（80-95）分。随访期间，肘关节正侧位 X 线片未见假体松动征象。
对于严重血友病性肘关节炎患者，全肘关节置换术的短期治疗效果良好，严格遵循手术适应证，做好围手术期准备。改良截骨术可充分暴露术野，减少尺神经损伤并发症。长期效果有待进一步研究。
